Sunday, November 8, 2015

Atul Gawande is a well-known surgeon who has written several best-selling novels on a variety of topics in Medicine. In the Checklist Manifesto, he discusses the importance of using checklists to reduce error and improve overall quality and safety. I am interested in Hospital Medicine after I complete my residency training and Quality Improvement is an important part of this job. Gawande spends a good portion of the book recounting his experiences working with the World Health Organization to develop a surgical safety checklist to be implemented in hospitals around the world. He was quite successful in this endeavor and use of this checklist led to substantial reductions in surgical error and post-op complications. Subsequently, surgical safety checklists have become the standard of care in hospitals everywhere.

While part of being a leader is being creative and thinking out of the box, when you are stuck, one should always go back to the basics. Checklists are such a simple concept, but like Gawande, I have found them to be extremely useful. When the human brain is under stress at work or in situations that are life-threatening, like those experienced by the pilots and emergency response teams in this book, it forgets even the most basic things. Checklists are there to ensure that this stress-induced memory loss does not lead to serious and sometimes fatal consequences. The reason that The Checklist Manifesto has such an impact on the reader is because, like the author's other books, it includes many stories of how checklists have saved lives in hospitals and other situations.

In the future, my goal is to use these concepts and the power of a checklist to reduce patient error and improve overall quality of care. To scoff at the use of checklists in the hospital would not be wise - I have interacted with many overwhelmed and overworked healthcare providers, whose lapses in judgement have led to infections, blood clots, heart attacks, cardiac arrests, and numerous other complications. No provider intentionally makes these mistakes, but we are only human, and it is unfortunately inevitable. All we can do is try to reduce error as much as possible, and as one can see from the results in Gawande's book, the reductions in error with the use of checklists are quite astounding.

In technical terms, the book is well written, and I think it will appeal to not only healthcare providers, but also to the general population. The author includes examples of checklists in many different fields, including but not limited to medicine, aviation, cooking, and construction. The only downside to this book, for me, is that it didn't have that "can't put down" quality that most of my favorite books have. It took me a very long time to get through the book, but once I had finished, I found it to be time well spent.

I look forward to reading more by this author. I recently bought his book, Being Mortal, regarding end of life care in the United States, and I am looking forward to starting it.